Name: margalit
Location: Massachusetts, United States Professional writer, educational advocate, opinionated ultra liberal mother of 18 year old twins, living life in the slow lane due to hypertrophic cardiomyopathy, congestive heart failure, and diabetes.

email: margalitc at yahoo dot com

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Wednesday, July 20, 2005

My Achy Breaky Heart

Saw the cardiologist today for my regular 3 month checkup. She asked again about getting the pacemaker-defribillator. I relented and said I'd do it, not that I want to, but because I know it's the safest thing to do. I have to go and see another electrocardiologist, who will determine what kind I need, and Dr. J says that she'll probably want to do the genetic testing to see what kind of HCM I have. I'm fine with the testing, as it will make it easier to find out if the kids have inherited it, as well as other family members. The kids have had an initial echo at 12 YO, both passed with flying colors, but then again, they don't do a lot of daily sports activities. I need to know if they have HCM before they get involved in high school sports.

Anyhow, I made the appointment, and now I'm doing the research on the damn implanted nuisance. This is what I've come up with:

How does an ICD work?

An ICD is usually about the size of a pager. It is made up of two parts:

  • A pulse generator, which includes the battery and several electronic circuits.
  • Wires, called leads. Depending on the type of ICD, you may have one or two leads.

The ICD is implanted beneath the skin, near the collarbone or somewhere at or above the waistline. The leads are placed inside the heart or on its surface and are attached to the ICD.

ICD implant surgery has become a very common procedure. It is done while you are asleep, but it is not open heart surgery. After the device is implanted, doctors will perform electrophysiology studies (EPS) to make sure that the device is working properly. The procedure usually takes about two hours. You will need to stay in the hospital for at least one night after the device is implanted. Antiarrhythmic medicines may also be prescribed.

Some of the newer, smaller devices have simpler lead systems, which can be inserted with a catheterization procedure.

Once the ICD is implanted, the leads monitor your heart rate. If the ICD detects ventricular tachycardia or fibrillation, it sends out a controlled burst of impulses (called "overdrive" pacing). If that does not work, the ICD "shocks" the heart to restore a normal rhythm. Newer ICD devices can also work like a pacemaker if a slow heart rate (bradycardia) occurs.

When ventricular tachycardia or fibrillation occurs, the ICD records your heart rate, as well as the date and time of the event. It can also record what electrical therapy was needed to restore a normal heart rhythm.

What will I feel when my ICD gives me a "shock"?

Tachycardia is usually corrected with very small electrical impulses. You may feel a flutter, palpitations (like your heart is skipping a beat), or nothing at all. Fibrillation may require that you receive a "shock." Most patients say that the shock feels like a sudden jolt or thump to the chest. Some people black out during fibrillation, so they may not feel anything when the shock is given. If someone is touching you while you are receiving a shock, they may feel a small muscle jerk, but it will not hurt them.

Your doctor will tell you what to do after you have received a shock. Some patients' doctors will have them call the doctor's office after a shock has been given. Most doctors will want to know if you have received two or more shocks within 24 hours.

How often do I need to get my ICD checked?

After you get your ICD, you will have to go to the doctor for regular check-ups. ICDs can also be checked over the telephone. This is called transtelephonic monitoring. Even with telephone monitoring, you will still need to go to your doctor's office for regular check-ups.

The ICD is checked with a device called a programmer. When the programmer is held over the ICD, your doctor is able to tell if the ICD is working properly, how much power is left in the battery, and if the device has delivered therapy. The programmer can also be used to change the settings of the ICD.

An ICD battery usually lasts anywhere between 4 and 8 years, depending on how many shocks it sends. When the battery runs down, a new ICD will be implanted. In most cases, your original ICD leads will not need to be replaced.

Will electronic devices affect my ICD?

If you have an ICD, you should always be aware of your surroundings. It is safe for you to be around wood working tools and normal home appliances, including microwave ovens. Stay away from heavy equipment that has very strong magnetic fields or strong electric fields (antennas, arc welders, and industrial equipment). Your doctor will help you understand what to avoid when you have an ICD.

Can I still drive a car if I have an ICD?

Many doctors will tell you not to drive for 6 months after your implantation surgery or after a shock. Talk to your doctor if you are not sure if it is safe for you to drive.

Can I use my cell phone if I have an ICD?

You should keep your cell phone at least 6 inches away from your ICD. When you are talking on your cell phone, hold it on the opposite side of the body from your ICD. Do not carry your cell phone in your breast pocket or on your belt if that means that it will be within 6 inches of your ICD.

Let me just mention that I am NOT thrilled to read about the driving and the cellphone usage. I think this is going to be a major PITA, but what am I going to do?

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